Demand for locum tenens physicians, particularly in hospital medicine, is increasing. In 2012, 73.6% of health care facility managers reported using locum tenens physicians; two years later that percentage had grown to 91%, according to a survey by Staff Care, a locum tenens placement firm. Several factors are contributing to the need for temporary physicians.
Causes include the increase in the number of insured patients, the aging population with its many chronic conditions, and the aging of physicians as a group. More than a third of doctors are now over the age of 55 and moving into retirement, according to the Association of American Medical Colleges (AAMC).
The AAMC anticipates a shortage of 61,700 to 94,700 physicians nationwide by 2020, with that shortage expected to be addressed, in part, by locum tenens physicians. About 22% of locum tenens positions in 2014 were in hospital medicine, the third highest percentage of any physician specialty, according to Bob Wolf, a division vice president at Staff Care in Dallas.
“We expect the future of hospitalist locum practice will continue to be active as hospitals' recruiting needs remain unmet in so many markets,” said Talbot “Mac” McCormick, MD, ACP Member, CEO of LocumConnections in Atlanta, another locum tenens placement firm.
“We have seen steady growth and recently accelerated growth in utilization of hospitalist physician locum tenens, as well as utilization of advanced practitioners in hospital medicine,” agreed Mr. Wolf.
Consolidation creates need
Consolidation of hospitalist management groups is another factor expanding the pool of hospitalists interested in locums practice, as well as the need for them, experts said.
According to Mr. Wolf, consolidation can result in a 10% to 40% turnover in professional staff, with a subsequent demand for locum tenens physicians to fill that gap. These larger companies may also move into new facilities and need locums there. “Expansion of a group, taking on more hospitals, is where locums are playing a large role in helping staff up the expanded programs,” said Mr. Wolf.
“There are opportunities to redistribute permanent providers, but most providers filling full-time spots at a hospital in the town where they live are not generally interested in traveling to other sites, so the need for locums typically persists,” added Dr. McCormick.
On the other hand, for some young physicians, hitting the road is just the thing. Malika Manyam, MD, is a young hospitalist who has worked as a locum physician for three of the four years since she finished her residency in 2012. Affiliated with Staff Care, she is currently a locum tenens hospitalist at Rockingham Memorial Hospital in Harrisonburg, Va., which is about two hours from her home in that state. She has also worked at hospitals in New Jersey, Virginia, Tennessee, and Massachusetts.
“I realized that the more I moved around and the more that I did locums, the more that I developed my own identity as a physician. As a young physician coming out of residency, it really helped me to sit back and think about what kind of physician I want to be, what kind of setting I want to be in,” she said.
Immediately after residency, many of her peers looked at locum positions as a temporary solution while they were trying to sort out where they wanted to work, according to Dr. Manyam. “What I am now seeing is that there is a trend that after they have been working at a place for a few years, they are deciding that an employee position is just not right for them,” she said.
Dr. Manyam's model of moving right from residency to locums represents a new and growing dynamic. Locum positions have traditionally been filled by older and more experienced physicians, but that seems to be changing.
According to the Staff Care survey, in 2014, 21% of newly trained physicians sought locum positions; in 2012, that number was 14.3%. In 2014, the percentage of locum physicians ages 40 and younger was 14%, compared with 6.1% the year before.
“We are seeing more and more residents looking to do locums to gain experience and to pay off their student loans faster,” Dr. McCormick said. “While permanent full-time positions offer the ability to settle down in a community, physicians who weigh schedule flexibility and potential for income as higher priorities are finding that locums practice offers them the benefits they are seeking.”
Another reason is that many young physicians want to experience different areas of the country before they plant roots and settle in, Mr. Wolf said. “They also want to build their resume, and they can do that by working locum tenens at various work settings or at prestigious hospitals.”
Whereas rural areas once had the greatest need for locum physicians because of recruitment difficulties, there is now increasing need in metropolitan areas where physician shortages and patient demands are growing, according to Mr. Wolf.
Another change in locum hospitalist recruitment has come out of hospitals' increasing focus on quality metrics. “Our clients no longer accept the first provider submitted for consideration, and they often prefer multiple candidates to find the best fit to meet their needs. At the end of the day, adequate staffing levels of physicians and advanced practitioners are critical to quality patient outcomes and patient satisfaction scores,” said Mr. Wolf.
Given the increasing focus on quality metrics, hospitals are more demanding about the clinical acumen, organization, and teamwork skills of potential locums, just like their permanent hospitalists, Dr. McCormick noted.
The system is working so far for Dr. Manyam. Despite living in a hotel away from her husband every other week and having to navigate complications of benefits, taxes, health insurance, and retirement planning and saving, she intends to stay at her current hospital as a locum tenens physician as long as there continues to be a need.
“The biggest key to success is to like what you are doing,” she said. “Doing locums and not having to entangle myself in the politics of how the hospitalist program is run allows me to be a little bit freer to enjoy what I do. I have been to some amazing hospitals. . . . and I have had really good experiences.”